Extended Daily Diafiltration (EDD-f)Advancing acute treatment for your critical care needs

Acute Therapy Systems

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1. Kielstein JT, Hafer C, Fliser D. "Sixty years of extended dialysis in the ICU“; 2006 Yearbook of Intensive care and emergency medicine", by: Vincent J.-L. 680-689.

2. Bellomo R, Baldwin l, Fealy N. Prolonged intermittent renal replacement therapy in the intensive care unit. Crit Care Resusc 2002;4:281–290.

3. Marshall MR, Tianmin M, Galler, D, et al. Sustained low-efficiency daily diafiltration (SLEDD-f) for critically ill patients requiring renal replacement therapy: towards an adequate therapy. Nephrol Dial Transplant 2004;19:877–844

4. Kumar VA, Craig M, Depner, TA, et al. Extended daily dialysis: a new approach to renal replacement for acute renal failure in the intensive care unit. Am J Kidney Dis 2000;36:294–300.

5. Marshall MR, Golper TA, Shaver MJ, et al. Sustained low-efficiency dialysis for critically ill patients requiring renal replacement therapy. Kidney Int 2001;60:777–785.

6. Vanholder R, van Biesen WIM, Lameire N. What is the renal replacement therapy of first choice for intensive care patients? J Am Soc Nephrol 2001;12:S40–43.

7. Acute Dialysis Quality Initiative (ADQI). ADQI 1: CRRT: Solute control in CRRT. Available at: www.ccm.upmc.edu/adqi/adqi01.html (accessed: August 2007).

References

EDD-f: The Promising Technique For Now And The Future

Innovative treatment for your critical care needs

EDD-f is a hybrid therapythat delivers a gentle yet effective Diffusive and Convective treatment for acute renal failure patients.

Extended daily diafiltration (EDD-f)

Combining the advantages of conventional dialysis and CRRT, EDD-f further enhances renal replacement techniques in treating acute renal failure.

As part of the long-standing commitment to advancing acute therapies, Fresenius Medical Care will continue to lead in this field to develop innovative treatment tools and promising new techniques serving the medical needs today and in the future.

EDD-f Offers Haemodynamic Stability To Critically Ill Patients

• Excellent patient tolerance with well-maintained blood pressure and heart rate2

• Ultrafiltration (UF) volumes delivered are close to prescribed goals3

• Extended treatment duration allows for slower UF rates, which contribute to haemodynamic stability,

adequate fluid control and dose delivery

• Corrects fluid overload while allowing administration of vital fluids such as parenteral nutrition, blood

products and various intravenous infusions4

Extended Daily Diafiltration (EDD-f)Hybrid Technique Created for Acute Renal Failure

EDD-f Avoids Solute Disequilibrium and Re-establishes Acid/base Balance

• Excellent clinical achievements with 63% decrease in blood urea levels and a 53% decrease in creatinine levels3

• Good acid/base control due to significant removal of lactate and the use of bicarbonate-buffered dialysate

and replacement solutions

• Avoidance of rapid concentration shifts and associated changes in cerebral volume with an extended

treatment time

• Online production of bicarbonate-buffered solutions lets the user adjust electrolyte concentrations

customized to each patient’s requirements

Extended dialysis in treating acute renal failure was first performed by W.J. Kolff in 19451. In the last sixty

years, numerous forms of hybrid techniques have been evolved to treat critically ill patients in ICU. These new

treatments include:

• Extended dialysis – ED

• Slow continuous haemodialysis

• Extended daily dialysis – EDD

• Sustained low efficiency dialysis – SLED

• Sustained low efficiency daily diafiltration – SLEDDf

• Prolonged intermittent renal replacement therapy – PIRRT

• Prolonged daily intermittent renal replacement therapy – PDIRRT

• And many other related, descriptive terminologies

EDD-f: Evolving Beyond All ExpectationsGlobally, renal replacement therapy for acute renal failure varies greatly in practice. EDD-f combines the best

aspects of various treatment modalities by adding the therapeutic advantages of continuous renal replacement

therapy (CRRT) to operational and cost benefits of conventional haemodialysis (IHD).

• The high efficiency of EDD-f achieves treatment goals in 8–10 hours. Machine utilization is enhanced with

increased patient flow

• • EDD-f allows patients to be accessible and to be mobilized for other medical treatments2,3

• • Circuit clotting and heparin requirements are greatly reduced. This is particularly beneficial to patients with

severe bleeding tendencies3,4

•• Re-design of the dialysis machine for EDD-f provides a streamlined procedure suitable in treating

critically-ill patients and with less workload for operators4,5

Advancing Acute Treatment Using EDD-fData presented in this brochure are based on clinical experience with hybrid therapies from which EDD-f

evolved. Among available hybrid techniques, EDD-f offers additional convective clearance, providing enhanced

removal of middle to large solutes4, which is beneficial to patients with sepsis and multi-organ failures.

Achieves ultrafiltration goals with superior haemodynamic stability4

0

10

20

30

40

50

60

70

80

Pre-Treatment

Mid-Treatment

Post-Treatment

EDD

4,000

21,000

ERRT

0

5,000

10,000

15,000

20,000

25,000

Reduced Circuit Clotting With Less Anticoagulant For Simpler And Safer Treatment

• Circuit clotting occurs less frequently in EDD-f compared

with CRRT5

• Hourly heparin dose and total daily requirements are much less

than with CRRT4

• More heparin free treatments can be achieved than with CRRT4

• With a reduced need for heparin, EDD-f may be particularly

advantageous for patients with severe bleeding tendencies5

• Fresenius Polysulfone® haemofilters maximize biocompatibility.

This ensures minimal complications due to inflammation and

coagulation during treatment6,7

Logistical And Financial Advantages With Online Fluid Production Technology

The Fresenius DIASAFE® plus double filtration system generates ultrapure solution that reaches the

standard set by the European Pharmacopoeia (1997). Fresh solutions are prepared through precise

proportioning and mixing of electrolyte concentrates and bicarbonate buffer inside the machine.

This online technological innovation brings unsurpassed advantages:

• Increase convective clearance for larger solute removal3

• Individualize treatment allowing user prescribed electrolyte concentrations

• Reduce workload by easy machine operation and less handling

• Cost-saving by elimintating need for commercial solution bags

• Promising techniques such as high-volume haemofiltration can now be prescribed more safely, delivered

easily and at lower cost

Ultr

afilt

ratio

n vo

lum

e (m

L)

0

1,000

2,000

3,000

Hybrid CRRT

4,000

5,000

CRRT Hybrid

DIASAFE® plus reduces the endotoxin concentration of dialysate13

End

otox

in c

once

ntra

tion

(IU/m

I)

0.001

0.01

0.1

1

10

Upstream offirst filter

Downstream offirst filter

Downstream ofsecond filter

Ultrapure EU <0.03 IU/ml

Bac

teria

l con

cent

ratio

n (C

FU/m

l)

0.001

0.01

0

1000

10000

100000

DIASAFE® plus reduces the bacterial concentration of dialysate13

Upstream offirst filter

Downstream offirst filter

Downstream ofsecond filter

0

Hep

arin

IU p

er d

ay